xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

Volume 153, Number 2 • Cleft Palate Surgery

Fig. 1. Cleft palate: relevant anatomy. ( Left ) Native alignment of the levator muscle sling with a transverse orientation of the paired muscles. ( Right ) Cleft palate results in aberrant insertion of the levator muscle on the posterior hard palate with a sagittal orientation of the paired muscles.

Fig. 2. Submucous cleft palate. ( Left ) A 1-year-old child who presents with a midline palatal lucency, called the “zona pellucida” ( arrow ) that is typically visible because of separation of the levator muscles. This patient also has a notch in the posterior hard palate representing absence of the posterior nasal spine. Patients may also present with a bifid uvula. ( Right ) Schematic showing the constellation of findings in submucous cleft palate, often including a notch in the posterior hard palate and bifid uvula.

oriented transversely to form a sling that elevates the palate during phonation and constitute an important functional mechanism of the velo pharyngeal sphincter (Fig. 1, left ). Clefting dis rupts the anatomical alignment of these muscles as they assume a more sagittal vector inserting on the posterior border of the hard palate, dis rupting normal muscle function and impacting speech resonance and the ability to create plosive sounds (Fig. 1, right ). 9 In submucous cleft palate, the levator muscle alignment is disrupted, but the oral and nasal mucosa containing the mus cles is generally preserved (Fig. 2). Despite the preservation of separate oral and nasal cavities, speech may be affected in submucous cleft pal ate because of the aberrant muscle orientation, and close follow-up is indicated to determine

whether palatoplasty will be of benefit to these patients during their speech development. Cleft Palate Embryology Palatogenesis occurs between 5 and 12 weeks of human embryogenesis. 7 By the fourth week, the frontonasal, maxillary, and mandibular prom inences are established and surround the oral cavity. The frontonasal prominences divide into paired medial and lateral nasal processes. During the sixth week of embryonic development, the upper lip is formed by the fusion of the medial and lateral nasal processes with the maxillary pro cesses. The philtrum and the primary palate are formed by the subsequent fusion of the paired medial nasal processes in the midline. Failure of these steps results in cleft lip or cleft of the primary

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